Ranking Big Pharmas performance on access to medicines

Citizens in the developing world are suffering increasingly from the same diseases as the rich world — but they do not have the same access to life-saving treatments.

The 2018 Access to Medicine Index shows, for example, that of 11 new diabetes drugs approved by top regulators since 2016, in only two cases did the developer offer ways to make the drug accessible to people in developing countries.

The Index, published Tuesday, is an annual ranking of how Big Pharmas research priorities and sales models address global health needs. For the first time this year, it includes a look at access to cancer drugs, noting that 65 percent of cancer deaths now occur in low- and middle-income countries. There, the gap between innovation and access is even deeper: Of the 45 new drugs to treat key cancers in lower income countries that arrived on the market since 2016, only five came with so-called access plans.

In an interview, Access to Medicine Foundation Executive Director Jayasree K. Iyer and Research Lead Danny Edwards said corporate consolidation is also a concern. Five companies — GlaxoSmithKline, Novartis, Johnson & Johnson, Merck KGaA and Sanofi — are working on two-thirds of the projects for top R&D priorities.

How do companies priorities around cancer line up with unmet need around the world?

Danny Edwards: About 5 percent [of the cancer projects considered] had some sort of evidence that the company was considering how to make the product available and affordable in the countries that we look at.

To give you a bit of a benchmark, if you look at communicable diseases that we measure, 54 percent of those have some sort of plan in place to consider access.

What is driving that gap?

DE: [Communicable disease R&D] has been heavily influenced by donor activity and global health priorities, but developing drugs for cancer care is very commercially oriented. When companies are developing HIV products, theyre really thinking about access in low- and middle-income countries, in a way that they might not necessarily be thinking about cancer yet.

The other challenge is the health systems. We know that its not necessarily fair to expect companies to be making these comparatively complex products available in low- and middle-income countries right off the bat when their health systems [arent prepared]. So were also looking at the degree to which companies are supporting those health systems.

What are some of the priorities for cancer treatment in low- and middle-income countries?

Jayasree Iyer: The demand is really growing. Were expecting that by 2030, theres going to be about 21.5 million cases of cancer in Africa.

When North Americans are diagnosed with cancer, about 40 percent of them will die because of that particular cancer. In Africa, 78 percent of people who are diagnosed with cancer will die. Theres a huge inequity in terms of not only access, but care itself.

There are priorities in improving health regulatory systems. We need to improve literacy, we need to empower people to improve their own health.

Cancer (not to mention hepatitis C) treatments are hitting European health budgets hard. Do you foresee including high-income countries in your analysis at some point?

JI: Were guardians of the developing world, and a lot of these diseases affect low- and middle-income countries in a disproportionate way.

But 2 billion people dont have access to medicine and theyre everywhere in the world now. One of the findings was that there was a heavy consolidation of the industry; heavy lifting on priority R&D is done by pretty much five companies. Thats a cause for concern. Any change that these companies [make in their innovation strategy] will have a dire effect. Recent news [as an example]: Sanofi and Novartis are both leaving the [field of] novel antibiotic development.

Whats behind that consolidation?

DE: Around half of all the priority R&D is focused on malaria, HIV/AIDs, tuberculosis, Chagas disease and leishmaniasis. All of those five diseases have benefitted from a lot of global attention, international donors, specific initiatives, which has helped to bring the companies to the table. Thats a pretty good message: These are models that work.

But if you look at the rest of the pipeline, 13 of these 45 diseases have no projects at all. Some specific gaps: Were looking into cholera, theres been this big need for a vaccine. Syphilis, theres a need for a single-dose oral cure. And there isnt activity from these 20 companies.

Is this just a question for donors and companies, or is there a role for policymakers?

JI: Theres quite a big role in making sure that R&D policy matches with the global needs. We have to realize as a society that we cant take innovation for granted, even with priority-setting. Priority setting helps society focus on, “Here are the areas where we need today.”

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